[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Hypoglycaemia: recognising it and the nursing response, conscious and unconscious

# Hypoglycaemia: recognising it and the nursing response, conscious and unconscious

- Assessment

A sudden change in behaviour in a person with diabetes is a low until proven otherwise: check glucose and start the protocol.

Updated Nov 13, 2026

## Key points

- A sudden change in mood or mental status in a patient with diabetes: check glucose at once.
- Awake and able to swallow: a fast-acting carbohydrate (juice, sugary drink or glucose tablets) as the protocol states; recheck in about 15 minutes.
- Not able to swallow or unconscious: nothing by mouth, call for help and give glucagon or IV dextrose as the protocol states; place the patient on their side.
- Once recovered and able to swallow, give a snack or the meal so the low does not return.
- After a low, watch closely for 24 hours, tell the doctor and the next shift, and look for the cause.
- Older adults and patients on beta-blockers may have few or no warning signs.

## What it is

Hypoglycaemia is a blood glucose below the threshold the institution's protocol defines. Guidelines grade it in three levels: level 1 is a low value that needs attention, level 2 is a clinically important low that needs immediate treatment, and level 3 is a severe event in which the person needs another person's help to recover, whatever the number. In hospital, each institution must have a standard, nurse-initiated treatment protocol, so the nurse can act at once without waiting for an order. The response depends on whether the patient can swallow safely: a fast-acting carbohydrate by mouth if the patient is awake and can swallow; if not, nothing by mouth, and glucagon or IV dextrose as the protocol states.

## Reference values

- Level 1: low value; level 2: clinically important low that needs immediate treatment; level 3: severe event that needs another person's help, with no fixed value. The numeric thresholds are those of the institutional protocol.
- Early (autonomic) signs: shaking, sweating, fast heartbeat, hunger, anxiety, tingling of the lips or tongue.
- Signs of a more severe low: confusion, irritability, poor coordination, drowsiness, odd behaviour, seizures, loss of consciousness.
- Usual causes: insulin or a sulfonylurea with a late, missed or small meal; vigorous exercise; alcohol without food; a stopped feed; a lower steroid dose.

## What you need

- Glucose meter and supplies; the institution's hypoglycaemia protocol.
- A fast-acting carbohydrate on the unit; glucagon and IV dextrose as the protocol provides.
- IV access if the patient already has one.

## How to measure it (and why)

- Suspect a low with sweating, shaking, confusion or a sudden change in behaviour: early action prevents seizures and injury.
- Check capillary glucose at once; if no meter is at hand and the patient is awake, treat first: the risk of waiting is greater.
- Check whether the patient is awake and can swallow safely: this decides the route of treatment.
- Awake: give the fast-acting carbohydrate the protocol states; liquids act faster than solid food.
- Not awake or cannot swallow: nothing by mouth (risk of aspiration); call for help and give glucagon or IV dextrose per protocol.
- Place an unconscious patient on their side: glucagon can cause vomiting and this protects the airway.
- Recheck glucose after about 15 minutes and repeat the treatment if still low: symptoms should improve within 10–15 minutes.
- When the patient can swallow, give a snack or the next meal: the effect of the sugar is short.
- Tell the doctor, record the episode and the cause, and pass it on at handoff: the insulin plan may need to change.

## How to read it

- Symptoms that improve after the carbohydrate confirm a low even if no glucose was measured.
- A low repeated at the same time of day points to the insulin or the meal timing: report the pattern.
- No warning signs (hypoglycaemia unawareness) is more common with long-standing diabetes, frequent lows and beta-blockers.
- Confusion, poor coordination or drowsiness mean the low is more severe: the patient can no longer treat it alone and needs another person's help.

## Next step: when to call for help

- Call for urgent help: the patient cannot swallow, is unconscious, has a seizure or does not improve after treatment.
- Tell the doctor: every low, even if corrected, so the plan is reviewed.
- Tell the doctor: lows that repeat; after any low the risk of another one stays high for the next 24 hours.
- Hand over: the episode, the cause and the closer monitoring for the next 24 hours.

## Test yourself

Think of the answer, then tap the question to see it.

## A patient on insulin becomes confused and sweaty before lunch. What is the first action?

Check capillary glucose at once and start the hypoglycaemia protocol. A sudden change in behaviour in a person with diabetes is a low until proven otherwise.

## Why is nothing given by mouth to a patient with a low who cannot swallow?

Because of the risk of aspiration. The protocol uses glucagon or IV dextrose instead, and the patient is placed on their side.

## What follows the first treatment of a low in an awake patient?

Recheck glucose after about 15 minutes, repeat if still low, then give a snack or the meal, tell the doctor and record the episode.

## Which patients may have a low with few warning signs?

Older adults, people with long-standing diabetes or frequent lows, and patients taking beta-blockers.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/hypoglycaemia-recognising-it-and-the-nursing-response-conscious-and-unconscious/)

## Elsewhere in DurgiPedia

- [The physiological response to hypoglycemia](https://durgical.com/en/physiology/the-physiological-response-to-hypoglycemia/)

## Connections

## Related 4

- [Capillary blood glucose testing](https://durgical.com/en/nursing/capillary-blood-glucose-testing/)
- [Recognising deterioration and calling the rapid response team](https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/)
- [Giving insulin safely: types by action, pens and syringes, sites, rotation and storage](https://durgical.com/en/nursing/giving-insulin-safely-types-by-action-pens-and-syringes-sites-rotation-and-stora/)
- [Caring for the hospitalised patient with diabetes: glucose checks, meals, fasting for procedures and illness](https://durgical.com/en/nursing/caring-for-the-hospitalised-patient-with-diabetes-glucose-checks-meals-fasting-f/)

## Related conditions 1

- [Hypoglycaemia (including insulin-induced)](https://durgical.com/en/conditions/hypoglycaemia/)

## In Pharmacology 1

- [Glucagon](https://durgical.com/en/pharmacology/glucagon/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Nursing Pharmacology, 9.4: Antidiabetics](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Pharmacology_(OpenRN)/09%3A_Endocrine/9.04%3A_Antidiabetics) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2023); [16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC11635037/) (American Diabetes Association Professional Practice Committee, Diabetes Care (PMC), 2025); [Guía de práctica clínica para el diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo II en la población mayor de 18 años (GPC-2015-51), versión para pacientes](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/CA/gpc-pacientes-diabetes-mellitus-tipo2-poblacion-mayor-18-anos.pdf) (Ministerio de Salud y Protección Social de Colombia, 2015); [Glucagon injection (drug information)](https://medlineplus.gov/druginfo/meds/a682480.html) (MedlinePlus, U.S. National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/hypoglycaemia-recognising-it-and-the-nursing-response-conscious-and-unconscious/